Quality Care-Metrics (QCM) for Quality and Community Nursing

1. How Quality Care-Metrics (QCM) contribute to Quality and Community NursingAnne GallenHSE ONMSD National Lead QCM Director of Nursing & Midwifery Planning and DevelopmentDoctoral Candidate – IPA & UCD

2. Overview • Explore the roots of quality and safety • Policy influences driving quality and safety • Methods for judging care quality and safety • Measuring Nursing & Midwifery Care - QCM • Profiling Care Quality – Clinical Dashboards • Clinical Leadership in Community Nursing • Questions

3. Roots of High Quality Safe Patient Care • Florence Nightengale – 1850 • Healthcare complications - ‘unintentional consequence of medical intervention’ (Barr, 1956; Moser, 1959) • 1990 - U.S Institute of Medicine Quality Chasm Reports • 44,000 – 98,000 preventable medical errors/year • Huge variations in care practice and quality ranging from outstanding, sub-optimal to alarmingly poor • “Quality is the degree to which healthcare services for individuals and populations increase the likelihood of desired health outcomes….” (IOM, 1990) • 6 Domains of Quality = safe, effective, patient-centred, timely, efficient and equitable • Recommendations – healthcare organisations - measure the quality and safety of care

4. Key Policy Influences • Building a Culture of Patient Safety: Report of the Commission on Patient Safety and Quality Assurance (DoH&C, 2008) Lourdes Inquiry • Patient Safety Curriculum Guide; Multi-professional Edition (WHO, 2011) • US Nursing Research – Linda Aiken Association between nursing and patient outcomes • International Nursing Research • RN4CAST (2013) – nurse perceptions of safety and quality of care in acute hospitals

5. How safe is healthcare in Ireland • Approx 35,000 medical errors occur annually in Irish Hospitals (Hunter, 2008) • Plethora of HIQA reports outlined suboptimal care in Acute Hospitals, Maternity Services, Older Person Services, Disability Services, Hygiene Standards etc • Research evidence - Practice variation anecdotal (??)

6. HSE corporate support for Quality “Quality…is the delivery of effective care in an environment that is safe for patients, staff and the public..” 2015 - Quality Enablement through the Quality Improvement & Quality Assurance Divisions

7. Making Healthcare Safer: Methods for improving quality and safety • Regulation and inspection • Research & evaluation • Feedback - Patient and staff experience • Gather clinical DATA to measure the Quality of Care

8. How to measure Quality of Care: Donabedian SPO Framework

9. Measuring Care Processes Quality Care Metrics • Mandie Sunderland – NHS Foundation Trust • 2011/2012 - NMPD X 3 - North west, North east and Dublin North • Access to web based audit functionality Test Your Care • Contextualised UK Metrics to Irish standards, policies and procedures

10. How does QCM work? • Identified auditors enter data monthly for each ward through the web-based system - TYC • Results are immediate - displayed in real-time online – available to CNM/DON • Reports printed monthly by each CNM and displayed on ward/organisation communication boards • Results show areas of good practice and areas in need of improvement • Action plans are drawn up to enable improvement towards the standard –action plans stored online for tracking/trending

11. QCM - Indication of Care Quality 90%-100% = Green – Standard of care achieved 80%-89% = Amber – below standard - improvement and action plan required 79%-0% = Red – risk improvement and action plan required

12. TestYourCare Report

13. Action Plans for Improvement

14. Quality Care-Metrics launched International Nurses Day 2015 “Quality Care-Metrics are a measure of the nursing and midwifery clinical care processes, in healthcare settings in Ireland, aligned to evidenced based standards and agreed through national consensus” (HSE, 2015)

15. QCM – enabled through ICT www.testyourcare.com

16. Supporting documentation

17. QCM’s & Community Nursing • Training delivered to PHN’s in 6 of the 8 NMPD regions • Of the 6 regions trained 4 are currently collecting data

18. Public Health Nursing QCM’s Nursing Documentation (2015) • Nursing Assessment • Plan of Care • NMBI Guidance • Discharge Planning & Caseload Management • Medication Management • Patient Observations • Patient Experience • Falls/Pressure Ulcer Assessment

19. Developing QCM

20. Developing new QCM for PHN/Community Nursing • Work-stream established • Representation from all regions and wide range of professional grades • Academic support – UCD – Prof Laserina O’Connor • Patient voice nomination • Chairperson – NMPD South – Carmel Buckley • Project Officers – Martina Giltenane & Aoife Lane • Group scheduled to reconvene 30th June • Aim: • through a robust academic framework and professional consensus, identify and prioritise the suite of QCM and their respective indicators for PHN / Community Nursing.

21. Next Steps • Hand-held technology – ICT tablets • Enhance reporting functionality • Develop Nursing & Midwifery Clinical Dashboards • Education – focus on undergrad / post grad / and CPD • HSEland

22. Benefits of Quality Care-Metrics for Community Nursing • Provides the platform to measure, monitor and trend care quality data in a format that is accessible and timely • Provides the evidence that identifies the areas of good nursing practice and also the areas where improvement is required • Embeds awareness of evidenced-based clinical standards, policies and procedures • Places Safety & Quality of Care at the heart of service provision and delivery

23. A Final Word - Clinical Leadership in Community Nursing HSE (2010) “A Clinical Leader is a competent professional involved in providing direct and indirect clinical care, who enables oneself, and influences others to improve patient care” • Effective Clinical Leadership in Community Nursing enables safe patient care and ongoing improvement of care • QCM’s demonstrate the visibility and contribution of your role to safe and effective care

24. Thank You for Listening